Provider Demographics
NPI:1306099197
Name:JENNINGS, LOBELIA EDEN (RPH)
Entity type:Individual
Prefix:
First Name:LOBELIA
Middle Name:EDEN
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1261
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1261
Mailing Address - Country:US
Mailing Address - Phone:619-948-7596
Mailing Address - Fax:
Practice Address - Street 1:432 N. MAIN STREET
Practice Address - Street 2:RITEAID PHARMACIES
Practice Address - City:ALTURAS
Practice Address - State:CA
Practice Address - Zip Code:96101
Practice Address - Country:US
Practice Address - Phone:619-948-7596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA32732OtherSTATE LICENSE